Level of Community Preparedness for Ebola Virus Epidemics in the Democratic Republic of the Congo: A Multiple Case Study

The Ebola virus disease (EVD) epidemics analysis from the Democratic Republic of the Congo (DRC) and West Africa showed an increased frequency in the intervals between outbreaks and the unpreparedness of the local health system including the community in the response thereto. This study describes the level of DRC community preparedness for EVD and other epidemics in order to judge its potential involvement in epidemiological surveillance at the Health Zone (HZ) level. A secondary analysis was conducted on the data collected during the evaluation of the DRC epidemiological surveillance system, carried out from December 2015 to May 2016 in 32 HZs of the 16 provinces at risk of EVD. Data were collected using semi-structured interview with leaders of the Health Area Development Committees (HADC), village chiefs as well as by focus group with the women of the community. Those respondents were sampled through a purposive sampling strategy. Community preparedness was explored in terms of community organization, knowledge of epidemiological surveillance, and knowledge of EVD. Data were transcribed verbatim in French and analysed using thematic analysis. Some results were tabulated and summarized as proportion. A total of 72 communities were studied. The study showed that the community participates in epidemiological surveillance through the HADCs. The HADC members and community health workers (CHWs) conduct case searches in the community and case referrals to the health centres. The majority of CHWs and community members were unknowledgeable of epidemiological surveillance and very few had received training for epidemic prone diseases. Few knew how to actually describe the steps of a case search. The study also noted that the level of knowledge of the population on EVD in the communities visited was not optimal with a lot of erroneous data and a perception that could be harmful for epidemiological surveillance and outbreak response. The study showed that the population as a whole claimed to participate in epidemiological surveillance only through sensitization and the passing on of information. These study results show that the community at the local level in the DRC is not optimally prepared for EVD and other epidemics. These results suggest a strengthening of community preparedness in the DRC more extensively for diseases with epidemic potential through sensitization and social mobilization, in particular by strengthening the capacity of the teams of health centres, health committees and CHWs in terms of training, technical guides and simple prevention materials.